發(fā)布時(shí)間：2018-02-13 09:57

  本文關(guān)鍵詞： 肺栓塞 再發(fā)性肺栓塞 特發(fā)性肺栓塞 危險(xiǎn)因素 預(yù)后　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:再發(fā)性肺栓塞是嚴(yán)重影響肺栓塞患者預(yù)后和生存質(zhì)量的不良事件。本文通過分析患者的臨床資料,探討再發(fā)性肺栓塞的危險(xiǎn)因素,以期識別可能復(fù)發(fā)的高�；颊�,為早期干預(yù)提供科學(xué)依據(jù)。方法:回顧性分析自2008年1月至2015年12月期間在青島大學(xué)附屬醫(yī)院確診的658例初發(fā)肺栓塞患者的臨床資料,根據(jù)患者是否出現(xiàn)肺栓塞再發(fā)事件,將其劃分為再發(fā)組和非再發(fā)組,分析兩組間在性別、合并癥/危險(xiǎn)因素、殘余血栓、實(shí)驗(yàn)室檢查資料和影像學(xué)資料等方面是否有差異。采用t檢驗(yàn)、χ2檢驗(yàn)及非參數(shù)檢驗(yàn)分析后,對可能有意義的因素再行多因素Logistic回歸分析,篩選出再發(fā)性肺栓塞的獨(dú)立危險(xiǎn)因素。結(jié)果:658例肺栓塞患者中共有80例(12.16%)患者出現(xiàn)再發(fā)事件。80例再發(fā)患者中1年以內(nèi)出現(xiàn)再發(fā)事件例數(shù)最多,其中又以6-12月為著。合并癥/危險(xiǎn)因素方面:肺栓塞再發(fā)組合并惡性腫瘤者占25%,非再發(fā)組合并惡性腫瘤者占13.8%,惡性腫瘤在兩組間差異具有統(tǒng)計(jì)學(xué)意義(χ2=6.790,P=0.009)。臨床癥狀、體征方面:較非再發(fā)組患者而言,肺栓塞再發(fā)患者出現(xiàn)呼吸困難(58.8%vs 44.3%,P=0.015)較為常見。實(shí)驗(yàn)室資料方面:血尿酸升高可能是肺栓塞再發(fā)的危險(xiǎn)因素(P=0.001)。影像學(xué)資料方面:肺栓塞再發(fā)組與非再發(fā)組在右室擴(kuò)大(χ2=4.476,P=0.034)、右房擴(kuò)大(χ2=4.049,P=0.043)及重度肺動(dòng)脈高壓(χ2=5.041,P=0.025)方面具有統(tǒng)計(jì)學(xué)差異。早期死亡風(fēng)險(xiǎn)方面:對于區(qū)分肺栓塞是否再發(fā),肺栓塞早期死亡風(fēng)險(xiǎn)分層表現(xiàn)為組內(nèi)有統(tǒng)計(jì)學(xué)意義(χ2=13.774,P=0.03)。肺栓塞患者是否再發(fā)在低度死亡風(fēng)險(xiǎn)與中度死亡風(fēng)險(xiǎn)間有統(tǒng)計(jì)學(xué)差異(χ2=10.449,P=0.001)。殘余血栓方面:再發(fā)患者中殘余血栓的發(fā)生率為65.3%,非再發(fā)患者中殘余血栓的發(fā)生率為45.1%。再發(fā)組發(fā)生殘余血栓的可能性較大(χ2=9.754,P=0.002)。按照患者復(fù)查CTPA的時(shí)間分析顯示3個(gè)月后兩組間在殘余血栓方面差異有統(tǒng)計(jì)學(xué)意義(χ2=10.254,P=0.001)。心臟超聲表現(xiàn)為右心室擴(kuò)大(c2=4.584,P=0.032)、重度肺動(dòng)脈高壓(c2=10.809,P=0.001)及下肢靜脈超聲表現(xiàn)為下肢深靜脈血栓形成(c2=6.176,P=0.013)可能為殘余血栓的危險(xiǎn)因素。658例肺栓塞中特發(fā)性肺栓塞占17.5%。與非特發(fā)性肺栓塞相比,特發(fā)性肺栓塞出現(xiàn)再發(fā)事件較為常見(25.2%vs9.4%,P=0.000)。特發(fā)性肺栓塞發(fā)病年齡較非特發(fā)性肺栓塞年輕[(52.95±17.27)vs(62.71±13.99),P0.05]。特發(fā)性肺栓塞患者右心室擴(kuò)大(χ2=6.054,P=0.014)、重度肺動(dòng)脈高壓(χ2=16.467,P=0.000)較常見,且出現(xiàn)殘余血栓的比例高于非特發(fā)性肺栓塞(67.5%vs44.2%,P=0.000)。再發(fā)性肺栓塞的獨(dú)立危險(xiǎn)因素有惡性腫瘤(OR:2.952,95%CI:1.503-5.797),特發(fā)性肺栓塞(OR:2.852,95%CI:1.510-5.387),血尿酸水平(OR:1.003,95%CI:1.001-1.005)和殘余血栓(OR:1.811,95%CI:1.017-3.226)。結(jié)論:再發(fā)性肺栓塞的獨(dú)立危險(xiǎn)因素有合并惡性腫瘤、特發(fā)性肺栓塞、血尿酸水平和殘余血栓。右心室擴(kuò)大、重度肺動(dòng)脈高壓及下肢深靜脈血栓形成可能是殘余血栓的危險(xiǎn)因素。與非特發(fā)性肺栓塞相比,特發(fā)性肺栓塞患者發(fā)病年齡較輕,右心室擴(kuò)大、重度肺動(dòng)脈壓較為常見,發(fā)生殘余血栓的風(fēng)險(xiǎn)較高。
[Abstract]:Objective : To study the risk factors of recurrent pulmonary embolism by analyzing the clinical data of patients with pulmonary embolism . In terms of clinical symptoms and signs : dyspnea ( 58 . 8 % vs 44.3 % , P = 0.015 ) was more common in patients with recurrent pulmonary embolism ( P = 0 . 015 ) . There was a statistically significant difference between the risk of low mortality and the risk of moderate death in patients with pulmonary embolism ( 蠂2 = 10.449 , P = 0.001 ) . Residual thrombosis : The incidence of residual thrombosis in recurrent patients was 65.3 % , and the incidence of residual thrombosis in non - recurrent patients was 45.1 % . There was a large possibility of residual thrombosis in the recurrence group ( 蠂2 = 9.754 , P = 0.002 ) . The time analysis of CTPA was performed in accordance with the patient ' s time analysis showing statistically significant differences in residual thrombus between the two groups after 3 months ( 蠂2 = 10.254 , P = 0.001 ) . Heart ultrasound showed right ventricular enlargement ( c2 = 4.584 , P = 0.032 ) , severe pulmonary hypertension ( c2 = 10.809 , P = 0.001 ) , and lower extremity venous ultrasound ( c2 = 6.176 , P = 0.013 ) may be a risk factor for residual thrombosis . There were 658 cases of idiopathic pulmonary embolism ( 17.5 % vs 9.4 % , P = 0.000 ) . The incidence of idiopathic pulmonary embolism was ( 52.95 鹵 17.27 ) vs ( 62.71 鹵 13.99 ) , P < 0.05 ) . The right ventricular enlargement in patients with idiopathic pulmonary embolism ( 蠂 ~ 2 = 6.54 , P = 0.014 ) , severe pulmonary hypertension ( 蠂 ~ 2 = 16.467 , P = 0.000 ) were more common , and the proportion of residual thrombosis was higher than that of non - idiopathic pulmonary embolism ( 67.5 % vs 44.2 % , P = 0.000 ) . The independent risk factors for recurrent pulmonary embolism were malignancy ( OR : 2.952 , 95 % CI : 1.503 - 5.797 ) , idiopathic pulmonary embolism ( OR : 2.852 , 95 % CI : 1.510 - 5.387 ) , blood uric acid level ( OR : 1.003 , 95 % CI : 1.001 - 1.005 ) and residual thrombus ( OR : 1.811 , 95 % CI : 1.017 - 3.226 ) . Conclusion : The independent risk factors of recurrent pulmonary embolism include complicated malignant tumor , idiopathic pulmonary embolism , blood uric acid level and residual thrombus . Right ventricle enlargement , severe pulmonary hypertension and deep venous thrombosis of lower limb may be the risk factors of residual thrombus . Compared with non - idiopathic pulmonary embolism , the incidence of idiopathic pulmonary embolism is lighter , right ventricle is enlarged , severe pulmonary artery pressure is more common , and the risk of residual thrombosis is high .

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5

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